The Senate is supposedly set to vote on what the press is reporting as a “skinny” repeal of the Affordable Care Act, colloquially known as Obamacare. A key feature, again supposedly, of this latest incarnation to destroy the ACA is a repeal of the individual and employer mandates. This post focuses on the individual mandate, and why it will destroy health care as a right.
Health care as an American right has been articulated by many in Washington and been a focus of many writings. Health Care Must Remain A Right For health care to remain a right, health care services must be available and affordable. Our system of health care delivery is based, in general terms, on the insurance model, that is, doctors and hospitals where we seek and obtain treatment get paid through the health insurance we are able to purchase, particularly in the individual market if we do not obtain health care insurance through our employers. Health care insurance is available to us all, just like, for example, purchasing a Maserati or a Mercedes Benz is available for purchase because we can all walk into a showroom and buy one. The problem, of course, is that very few of us can afford to buy such luxury. And so it is with health care insurance, again in the individual market.
Obamacare took care of the affordability element by requiring that we all have to purchase insurance, including the young and healthy. In that way, insurers would be able to cover what we all find beneficial like coverage for pre-existing conditions; no caps on what is spent on the health care services we need on an annual basis; and allowing our kids to remain on their parents’ policies until age 26. Insurers cannot provide such coverages (and still make a profit) without sufficient funds coming in by way of premiums. As well, the government also provides subsidies to insurers, again to ensure that insurers have enough revenue to cover benefits we all now have and want to keep.
So now comes what the press reports as the Senate Republicans’ skinny bill that features elimination of the individual and employer mandates. So what happens if the insurance market sees that the Senate wants to take away a source of revenue to them that enables them to continue providing benefits? Utter chaos. The individual insurance market will go into uncontrollable spasms. Without the individual mandate, it is projected that 16 or so millions of Americans that are insured through the ACA will lose their insurance, again, because insurers will either no longer make available the insurance being provided, or, they will have to increase premiums to such an extent to make up for elimination of revenue provided through the individual mandate---projected at 20% for 2018 alone---and this makes insurance unaffordable. This is a deadly elixir which no Republican Senator should favor if they really want to govern instead of wanting to pass anything at any cost just to say we passed something. With health care, that cost will be the loss of American lives and, well, the health of Americans.
True, citizens of many counties in the country are suffering from few or no insurers providing health care insurance, or they have experienced insurers adjusting premiums upwards in order to make a profit while still providing the benefits that we all still want and need. But more Americans want ACA to remain the law than not; that the ACA is more popular now than ever before; and even those that initially wanted Obamacare overturned want it to remain. Concomitantly, seven years of experience since the law was passed has shown it needs some fixing. Shoring up the individual markets by motivating insurers to return to markets they have left would be a great start.
So, let’s fix the parts of the ACA that are clearly not working as intended, but putting a scalpel to the individual mandate is not the solution, particularly if we want to ensure that health care remains a right for us all.